Mandala Intervention on Mother-Infant Bonding and Parenting Self-Efficacy After Negative Birth Experiences

The Effect of a Mandala-Based Intervention on Mother-Infant Bonding and Parenting Self-Efficacy in Primiparous Women With a Negative Birth Experience: A Randomized Controlled Trial

The purpose of this randomized controlled trial is to evaluate the impact of a mandala-based art intervention on mother-infant bonding and parenting self-efficacy among primiparous women (first-time mothers) who have had a negative birth experience. The study focuses on how structured creative activities can support emotional recovery and maternal confidence in the early postpartum period. A total of 66 participants were randomly assigned to either a Mandala Coloring Group or a Free Coloring Group. The intervention group participated in a structured session involving guided breathing, imagery, and symbolic mandala drawing designed for stress reduction and emotional expression. The control group engaged in a non-guided, free coloring activity. Data were collected using standardized tools, including the Mother-Infant Bonding Scale, the Karitane Parenting Confidence Scale, and the State-Trait Anxiety Inventory. The primary goal is to determine if the mandala-based intervention leads to significant improvements in the bond between mother and infant and increases the mother's confidence in her parenting abilities. Secondary outcomes include changes in anxiety levels following the intervention. All procedures were conducted in a supportive environment under researcher supervision to ensure participant safety and data integrity.

This randomized controlled trial evaluates the effects of a mandala-based intervention on mother-infant bonding and parenting self-efficacy in primiparous women (first-time mothers) who experienced a negative birth experience.

Study Design and Population The study was conducted in the obstetrics clinic of a hospital. Power analysis indicated a minimum sample size of 44 participants to achieve 80% power at a 0.05 significance level. To account for potential attrition, the study aimed for 70 participants and was completed with 66 mothers (34 in the Mandala Group and 32 in the Free Coloring Group).

Inclusion Criteria Eligible participants included women who had a vaginal delivery, were within the first seven days postpartum, were primiparous with a singleton pregnancy, and self-reported a negative birth experience confirmed by a score of 37 or above on the Wijma Delivery Expectancy/Experience Questionnaire Version B. Participants were required to have no diagnosed psychological disorders and no communication difficulties.

Randomization and Procedure Participants were randomly assigned to either the Mandala Coloring Group or the Free Coloring Group using random allocation software. Data collection occurred at two time points: before and after the intervention.

Intervention Protocols The intervention was conducted face-to-face in a quiet, supportive environment under researcher supervision, typically when the infant was asleep. Each session lasted approximately 30 minutes.

Mandala Coloring Group: This structured relaxation process included brief information on mandala philosophy, five minutes of "box breathing" relaxation, and guided imagery of a seaside scene. Participants created and colored a "wish mandala" representing personal intentions, accompanied by shamanic drum rhythm music. The session concluded with the creation of a "stress mandala" using spiral drawings to symbolically release stress.

Free Coloring Group: This activity allowed participants to express emotions spontaneously without guidance. Participants began drawing without prior planning, and the resulting images were evaluated as personal reflections rather than artistic products.

Outcome Assessments The primary outcomes include changes in the Mother-Infant Bonding Scale and the Karitane Parenting Confidence Scale. Secondary outcomes include changes in anxiety levels measured by the State-Trait Anxiety Inventory. Ethical approval was obtained prior to the study, and all participants provided written informed consent in accordance with the Declaration of Helsinki.

Inclusion Criteria:

• Having had a vaginal delivery
• Scoring 37 or above on the Wijma Delivery Expectancy/Experience Questionnaire Version B (W-DEQ-B)
• Being within the first seven days postpartum
• Being primiparous (first-time mother) with a singleton pregnancy
• Self-reporting a negative or adverse birth experience
• The infant being rooming-in with the mother
• Having no diagnosed psychological disorders or problems
• Voluntarily agreeing to participate in the research
• Having no communication difficulties

Exclusion Criteria:

• Having a diagnosed psychiatric disorder or currently receiving psychiatric treatment
• Use of psychotropic medication during the postpartum period
• Experiencing severe obstetric complications (e.g., postpartum hemorrhage, eclampsia, emergency hysterectomy)
• Neonatal complications requiring admission to the neonatal intensive care unit (NICU)
• Having a multiple pregnancy (twins, triplets, etc.) or a cesarean delivery
• Severe communication difficulties or inability to understand study procedures
• Participation in another psychosocial or art-based intervention during the study period
• Withdrawal of consent at any stage of the study